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Medicare AdvantageAdministrativeMedium impact

Provider-Based Billing for recipients retroactively enrolled in Medicare managed care

Wisconsin Medicaid (ForwardHealth)·WI·Billing
Effective date
Oct 1, 2003
We identified it
Jun 20, 2026
Days to comply
—

Summary

Wisconsin Medicaid will now generate Provider-Based Billing claims for recipients retroactively enrolled in Medicare managed care, requiring providers to submit these claims to Medicare managed care plans within 120 days to avoid payment deferrals. Providers must return documentation showing the Medicare managed care plan processed the claims or face automatic payment deferrals from future Medicaid payments.

Action Required

Action needed
Within 120 days of receiving Provider-Based Billing notification: Submit Provider-Based Billing claims to Medicare managed care plans and return copy of Provider-Based Billing Summary with supporting documentation showing claim processing to Wisconsin Medicaid at PO Box 6220, Madison WI 53716-0220 or fax to (608) 221-4567. Billing team must establish tracking system for these claims to avoid automatic payment deferrals after 120 days.

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